PNP Review: Blood Disorders fals

Blood Disorders

• Anemia: deficiency of erythrocytes or hemoglobin
  • Causes: blood loss, inadequate erythrocyte production, destruction of formed RBCs
  • Assessment findings: inadequate RBC volume, tachycardia, tachypnea, cool, clammy skin, amenorrhea
  • Compensatory mechanisms: tachycardia, tachypnea, cool, clammy skin, amenorrhea
• Hypovolemic Anemia
  • Causes: sudden loss of large volume, chronic loss of small amounts of blood
  • Assessment findings: extreme pallor, tachycardia, hypotension, reduced urine output, altered consciousness, fatigue, chills, rapid respiratory rate
  • Medical management: blood transfusions, administration of oral, IV, or IM iron
  • Nursing process: monitor results of CBC, assess vital signs, monitor I&O
• Iron Deficiency Anemia
  • Causes: insufficient iron to produce hemoglobin
  • Assessment findings: reduced energy, feeling cold, fatigue, and dyspnea with minor physical exertion, rapid heart rate even at rest, decreased hemoglobin, hematocrit, and serum iron levels
  • Medical management: foods high in iron, blood transfusions
  • Nursing management: increase iron intake, collaborate with dietitian, administer iron supplement (IM Z-track)
• Sickle Cell Anemia
  • Causes: Hemoglobin A replaced by Hemoglobin S; sickle- or crescent-shaped erythrocytes from inadequate oxygen supply to blood
  • Assessment findings: jaundice, tachycardia, dyspnea, cardiomegaly, and dysrhythmias; stroke, acute chest syndrome
  • Medical management: supportive treatment, regular blood transfusions, bone marrow transplantation, prophylactic antibiotic therapy
  • Nursing process: assess health history, vital signs, physical assessment, evident dehydration, and pain; provide analgesics, oxygen, and fluids
• Hemolytic Anemia
  • Causes: chronic premature erythrocyte destruction
  • Assessment findings: jaundice, enlarged spleen, shock
  • Medical management: removing the cause, corticosteroids, blood transfusions
  • Nursing management: health history, supportive care, medication, teaching measures of self-care, arrange follow-up evaluations
• Thalassemia
  • Causes: hereditary hemolytic anemia
  • Assessment findings: Cooley's anemia: bronzing of the skin
  • Medical management: symptomatic, frequent transfusions, iron chelation therapy
  • Nursing management: bed rest, protect from infection, closely monitor blood transfusion
• Pernicious Anemia
  • Causes: lack of intrinsic factor necessary for absorption of vitamin B12
  • Assessment findings: stomatitis, glossitis, digestive disturbances, diarrhea, dyspnea with minimal exertion, jaundice, irritability, confusion, depression, numbness, and tingling in arms and legs, ataxia
  • Medical management: IM vitamin B12, physical therapy for permanent neurologic deficits
  • Nursing management: soft, bland diet, small, frequent meals, oral care, encourage and assist with ambulation, supervision
• Folic Acid Deficiency Anemia
  • Causes: immature erythrocytes, insufficient dietary intake of foods rich in folic acid
  • Assessment findings: severe fatigue, sore and beefy-red tongue, dyspnea, nausea, anorexia, headaches, weakness, light-headedness
  • Medical management: folic acid supplements, balanced diet
  • Nursing management: teaching, diet, oral hygiene, rest promotion

Leukocytosis and Leukemia

• Leukocytosis: proliferation of leukocytes, usually in immature form
  • Causes: genetic correlation, precipitating factors
  • Assessment findings: severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
  • Medical management: antineoplastic drugs, transfusions, transplantation: bone marrow, stem cell
  • Nursing process: assess history of symptoms, physical assessment, laboratory results, assess neutrophil, monitor platelet counts, assess for signs of bruising and petechiae, report hematuria or epistaxis
• Leukemia
  • Types: acute and chronic forms of lymphocytic and myelogenous leukemia
  • Assessment findings: severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
  • Medical management: antineoplastic drugs, transfusions, transplantation: bone marrow, stem cell
  • Nursing process: assess history of symptoms, physical assessment, laboratory results, assess neutrophil, monitor platelet counts, assess for signs of bruising and petechiae, report hematuria or epistaxis

Cancer

• Definition: abnormal, unregulated cell growth; neoplasms
  • Classifications: carcinomas, lymphomas, leukemias, sarcomas
  • TNM classification: tumor, node, metastasis
  • Stages: I to IV
• Etiology: genetic mutation, environmental factors, chemicals, radiation, viruses
  • Factors: chemical agents, environmental factors, diet, viruses, bacteria, medications, immune system
  • Signs and symptoms: headaches, weight loss, chronic pain, persistent fatigue, low-grade fever, infections
  • Diagnostic tests: client's history, physical examination, laboratory tests, imaging studies, biopsies
• Cancer treatment
  • Surgery: primary method of diagnosing, staging, and treating
  • Radiation: destroys cell by breaking a strand of DNA molecule, preventing growth
  • Chemotherapy: antineoplastic agents, cell cycle patterns
  • Targeted therapies: biologic response modifiers, monoclonal antibody immunotherapy, cancer vaccines
  • Stem cell transplant: replaces bone marrow destroyed by cancer or cancer treatments
• Nursing care plan
  • Nursing diagnosis: fatigue, imbalanced nutrition, disturbed body image
  • Interventions: encourage protein and calorie intake, plan care around energy level, administer antiemetics, explore strengths and resources

Coagulopathies

• Thrombocytopenia: platelet manufacture by bone marrow is decreased or platelet destruction by the spleen is increased
  • Causes: leukemia, malignant blood diseases, severe infections
  • Assessment findings: purpura, bleeding, internal hemorrhage
  • Medical management: eliminate cause, corticosteroids, transfusions
  • Surgical management: splenectomy
  • Nursing management: manage/minimize bleeding, apply pressure/tourniquet, ADR, taper corticosteroid dosage/frequency
• Hemophilia: clotting factor, inherited: mother to son
  • Assessment findings: oozing, severe bleeding, bleeding in joints
  • Diagnostic findings: coagulant factor assay
  • Medical management: transfusions, thrombin/fibrin application, fresh frozen plasma, direct pressure
  • Nursing management: health history, physical assessment, VS, prevent trauma, minimize bleeding, reduce pain or discomfort
• Disseminated Intravascular Coagulation (DIC)
  • Causes: shock, infections, trauma, burns, transfusion reaction, cancer, and obstetric complications
  • Assessment findings: petechiae, purpura, ecchymoses, tachycardia, hypotension, cold/mottled fingers and toes
  • Medical management: correction of the cause, replacement of platelets, coagulation factors, and fibrinogen
  • Nursing management: assess pain, signs of infection, fatigue, bleeding, thrombus formation, urine output, safety, prevent infection

Palliative Care

• Definition: neither hastens nor postpones death, provides pain relief and reduces distressing symptoms
  • Integrates the psychological and spiritual aspects of care
  • Provides support system to help clients live as actively as possible until death
  • Referral to support system to help clients' families cope during the client's illness and in their own bereavement
• Hospice care
  • Initiated for patients as they near the end of life
  • Emphasizes quality of life
  • Patient and family are included in plan of care
  • Provides support for a dignified and peaceful death
  • Palliative rather than curative

Blood Disorders

• Anemia: deficiency of erythrocytes or hemoglobin
  • Causes: blood loss, inadequate erythrocyte production, destruction of formed RBCs
  • Assessment findings: inadequate RBC volume, tachycardia, tachypnea, cool, clammy skin, amenorrhea
  • Compensatory mechanisms: tachycardia, tachypnea, cool, clammy skin, amenorrhea
• Hypovolemic Anemia
  • Causes: sudden loss of large volume, chronic loss of small amounts of blood
  • Assessment findings: extreme pallor, tachycardia, hypotension, reduced urine output, altered consciousness, fatigue, chills, rapid respiratory rate
  • Medical management: blood transfusions, administration of oral, IV, or IM iron
  • Nursing process: monitor results of CBC, assess vital signs, monitor I&O
• Iron Deficiency Anemia
  • Causes: insufficient iron to produce hemoglobin
  • Assessment findings: reduced energy, feeling cold, fatigue, and dyspnea with minor physical exertion, rapid heart rate even at rest, decreased hemoglobin, hematocrit, and serum iron levels
  • Medical management: foods high in iron, blood transfusions
  • Nursing management: increase iron intake, collaborate with dietitian, administer iron supplement (IM Z-track)
• Sickle Cell Anemia
  • Causes: Hemoglobin A replaced by Hemoglobin S; sickle- or crescent-shaped erythrocytes from inadequate oxygen supply to blood
  • Assessment findings: jaundice, tachycardia, dyspnea, cardiomegaly, and dysrhythmias; stroke, acute chest syndrome
  • Medical management: supportive treatment, regular blood transfusions, bone marrow transplantation, prophylactic antibiotic therapy
  • Nursing process: assess health history, vital signs, physical assessment, evident dehydration, and pain; provide analgesics, oxygen, and fluids
• Hemolytic Anemia
  • Causes: chronic premature erythrocyte destruction
  • Assessment findings: jaundice, enlarged spleen, shock
  • Medical management: removing the cause, corticosteroids, blood transfusions
  • Nursing management: health history, supportive care, medication, teaching measures of self-care, arrange follow-up evaluations
• Thalassemia
  • Causes: hereditary hemolytic anemia
  • Assessment findings: Cooley's anemia: bronzing of the skin
  • Medical management: symptomatic, frequent transfusions, iron chelation therapy
  • Nursing management: bed rest, protect from infection, closely monitor blood transfusion
• Pernicious Anemia
  • Causes: lack of intrinsic factor necessary for absorption of vitamin B12
  • Assessment findings: stomatitis, glossitis, digestive disturbances, diarrhea, dyspnea with minimal exertion, jaundice, irritability, confusion, depression, numbness, and tingling in arms and legs, ataxia
  • Medical management: IM vitamin B12, physical therapy for permanent neurologic deficits
  • Nursing management: soft, bland diet, small, frequent meals, oral care, encourage and assist with ambulation, supervision
• Folic Acid Deficiency Anemia
  • Causes: immature erythrocytes, insufficient dietary intake of foods rich in folic acid
  • Assessment findings: severe fatigue, sore and beefy-red tongue, dyspnea, nausea, anorexia, headaches, weakness, light-headedness
  • Medical management: folic acid supplements, balanced diet
  • Nursing management: teaching, diet, oral hygiene, rest promotion

Leukocytosis and Leukemia

• Leukocytosis: proliferation of leukocytes, usually in immature form
  • Causes: genetic correlation, precipitating factors
  • Assessment findings: severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
  • Medical management: antineoplastic drugs, transfusions, transplantation: bone marrow, stem cell
  • Nursing process: assess history of symptoms, physical assessment, laboratory results, assess neutrophil, monitor platelet counts, assess for signs of bruising and petechiae, report hematuria or epistaxis
• Leukemia
  • Types: acute and chronic forms of lymphocytic and myelogenous leukemia
  • Assessment findings: severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
  • Medical management: antineoplastic drugs, transfusions, transplantation: bone marrow, stem cell
  • Nursing process: assess history of symptoms, physical assessment, laboratory results, assess neutrophil, monitor platelet counts, assess for signs of bruising and petechiae, report hematuria or epistaxis

Cancer

• Definition: abnormal, unregulated cell growth; neoplasms
  • Classifications: carcinomas, lymphomas, leukemias, sarcomas
  • TNM classification: tumor, node, metastasis
  • Stages: I to IV
• Etiology: genetic mutation, environmental factors, chemicals, radiation, viruses
  • Factors: chemical agents, environmental factors, diet, viruses, bacteria, medications, immune system
  • Signs and symptoms: headaches, weight loss, chronic pain, persistent fatigue, low-grade fever, infections
  • Diagnostic tests: client's history, physical examination, laboratory tests, imaging studies, biopsies
• Cancer treatment
  • Surgery: primary method of diagnosing, staging, and treating
  • Radiation: destroys cell by breaking a strand of DNA molecule, preventing growth
  • Chemotherapy: antineoplastic agents, cell cycle patterns
  • Targeted therapies: biologic response modifiers, monoclonal antibody immunotherapy, cancer vaccines
  • Stem cell transplant: replaces bone marrow destroyed by cancer or cancer treatments
• Nursing care plan
  • Nursing diagnosis: fatigue, imbalanced nutrition, disturbed body image
  • Interventions: encourage protein and calorie intake, plan care around energy level, administer antiemetics, explore strengths and resources

Coagulopathies

• Thrombocytopenia: platelet manufacture by bone marrow is decreased or platelet destruction by the spleen is increased
  • Causes: leukemia, malignant blood diseases, severe infections
  • Assessment findings: purpura, bleeding, internal hemorrhage
  • Medical management: eliminate cause, corticosteroids, transfusions
  • Surgical management: splenectomy
  • Nursing management: manage/minimize bleeding, apply pressure/tourniquet, ADR, taper corticosteroid dosage/frequency
• Hemophilia: clotting factor, inherited: mother to son
  • Assessment findings: oozing, severe bleeding, bleeding in joints
  • Diagnostic findings: coagulant factor assay
  • Medical management: transfusions, thrombin/fibrin application, fresh frozen plasma, direct pressure
  • Nursing management: health history, physical assessment, VS, prevent trauma, minimize bleeding, reduce pain or discomfort
• Disseminated Intravascular Coagulation (DIC)
  • Causes: shock, infections, trauma, burns, transfusion reaction, cancer, and obstetric complications
  • Assessment findings: petechiae, purpura, ecchymoses, tachycardia, hypotension, cold/mottled fingers and toes
  • Medical management: correction of the cause, replacement of platelets, coagulation factors, and fibrinogen
  • Nursing management: assess pain, signs of infection, fatigue, bleeding, thrombus formation, urine output, safety, prevent infection

Palliative Care

• Definition: neither hastens nor postpones death, provides pain relief and reduces distressing symptoms
  • Integrates the psychological and spiritual aspects of care
  • Provides support system to help clients live as actively as possible until death
  • Referral to support system to help clients' families cope during the client's illness and in their own bereavement
• Hospice care
  • Initiated for patients as they near the end of life
  • Emphasizes quality of life
  • Patient and family are included in plan of care
  • Provides support for a dignified and peaceful death
  • Palliative rather than curative

Blood Disorders

• Anemia: deficiency of erythrocytes or hemoglobin
  • Causes: blood loss, inadequate erythrocyte production, destruction of formed RBCs
  • Assessment findings: inadequate RBC volume, tachycardia, tachypnea, cool, clammy skin, amenorrhea
  • Compensatory mechanisms: tachycardia, tachypnea, cool, clammy skin, amenorrhea
• Hypovolemic Anemia
  • Causes: sudden loss of large volume, chronic loss of small amounts of blood
  • Assessment findings: extreme pallor, tachycardia, hypotension, reduced urine output, altered consciousness, fatigue, chills, rapid respiratory rate
  • Medical management: blood transfusions, administration of oral, IV, or IM iron
  • Nursing process: monitor results of CBC, assess vital signs, monitor I&O
• Iron Deficiency Anemia
  • Causes: insufficient iron to produce hemoglobin
  • Assessment findings: reduced energy, feeling cold, fatigue, and dyspnea with minor physical exertion, rapid heart rate even at rest, decreased hemoglobin, hematocrit, and serum iron levels
  • Medical management: foods high in iron, blood transfusions
  • Nursing management: increase iron intake, collaborate with dietitian, administer iron supplement (IM Z-track)
• Sickle Cell Anemia
  • Causes: Hemoglobin A replaced by Hemoglobin S; sickle- or crescent-shaped erythrocytes from inadequate oxygen supply to blood
  • Assessment findings: jaundice, tachycardia, dyspnea, cardiomegaly, and dysrhythmias; stroke, acute chest syndrome
  • Medical management: supportive treatment, regular blood transfusions, bone marrow transplantation, prophylactic antibiotic therapy
  • Nursing process: assess health history, vital signs, physical assessment, evident dehydration, and pain; provide analgesics, oxygen, and fluids
• Hemolytic Anemia
  • Causes: chronic premature erythrocyte destruction
  • Assessment findings: jaundice, enlarged spleen, shock
  • Medical management: removing the cause, corticosteroids, blood transfusions
  • Nursing management: health history, supportive care, medication, teaching measures of self-care, arrange follow-up evaluations
• Thalassemia
  • Causes: hereditary hemolytic anemia
  • Assessment findings: Cooley's anemia: bronzing of the skin
  • Medical management: symptomatic, frequent transfusions, iron chelation therapy
  • Nursing management: bed rest, protect from infection, closely monitor blood transfusion
• Pernicious Anemia
  • Causes: lack of intrinsic factor necessary for absorption of vitamin B12
  • Assessment findings: stomatitis, glossitis, digestive disturbances, diarrhea, dyspnea with minimal exertion, jaundice, irritability, confusion, depression, numbness, and tingling in arms and legs, ataxia
  • Medical management: IM vitamin B12, physical therapy for permanent neurologic deficits
  • Nursing management: soft, bland diet, small, frequent meals, oral care, encourage and assist with ambulation, supervision
• Folic Acid Deficiency Anemia
  • Causes: immature erythrocytes, insufficient dietary intake of foods rich in folic acid
  • Assessment findings: severe fatigue, sore and beefy-red tongue, dyspnea, nausea, anorexia, headaches, weakness, light-headedness
  • Medical management: folic acid supplements, balanced diet
  • Nursing management: teaching, diet, oral hygiene, rest promotion

Leukocytosis and Leukemia

• Leukocytosis: proliferation of leukocytes, usually in immature form
  • Causes: genetic correlation, precipitating factors
  • Assessment findings: severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
  • Medical management: antineoplastic drugs, transfusions, transplantation: bone marrow, stem cell
  • Nursing process: assess history of symptoms, physical assessment, laboratory results, assess neutrophil, monitor platelet counts, assess for signs of bruising and petechiae, report hematuria or epistaxis
• Leukemia
  • Types: acute and chronic forms of lymphocytic and myelogenous leukemia
  • Assessment findings: severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
  • Medical management: antineoplastic drugs, transfusions, transplantation: bone marrow, stem cell
  • Nursing process: assess history of symptoms, physical assessment, laboratory results, assess neutrophil, monitor platelet counts, assess for signs of bruising and petechiae, report hematuria or epistaxis

Cancer

• Definition: abnormal, unregulated cell growth; neoplasms
  • Classifications: carcinomas, lymphomas, leukemias, sarcomas
  • TNM classification: tumor, node, metastasis
  • Stages: I to IV
• Etiology: genetic mutation, environmental factors, chemicals, radiation, viruses
  • Factors: chemical agents, environmental factors, diet, viruses, bacteria, medications, immune system
  • Signs and symptoms: headaches, weight loss, chronic pain, persistent fatigue, low-grade fever, infections
  • Diagnostic tests: client's history, physical examination, laboratory tests, imaging studies, biopsies
• Cancer treatment
  • Surgery: primary method of diagnosing, staging, and treating
  • Radiation: destroys cell by breaking a strand of DNA molecule, preventing growth
  • Chemotherapy: antineoplastic agents, cell cycle patterns
  • Targeted therapies: biologic response modifiers, monoclonal antibody immunotherapy, cancer vaccines
  • Stem cell transplant: replaces bone marrow destroyed by cancer or cancer treatments
• Nursing care plan
  • Nursing diagnosis: fatigue, imbalanced nutrition, disturbed body image
  • Interventions: encourage protein and calorie intake, plan care around energy level, administer antiemetics, explore strengths and resources

Coagulopathies

• Thrombocytopenia: platelet manufacture by bone marrow is decreased or platelet destruction by the spleen is increased
  • Causes: leukemia, malignant blood diseases, severe infections
  • Assessment findings: purpura, bleeding, internal hemorrhage
  • Medical management: eliminate cause, corticosteroids, transfusions
  • Surgical management: splenectomy
  • Nursing management: manage/minimize bleeding, apply pressure/tourniquet, ADR, taper corticosteroid dosage/frequency
• Hemophilia: clotting factor, inherited: mother to son
  • Assessment findings: oozing, severe bleeding, bleeding in joints
  • Diagnostic findings: coagulant factor assay
  • Medical management: transfusions, thrombin/fibrin application, fresh frozen plasma, direct pressure
  • Nursing management: health history, physical assessment, VS, prevent trauma, minimize bleeding, reduce pain or discomfort
• Disseminated Intravascular Coagulation (DIC)
  • Causes: shock, infections, trauma, burns, transfusion reaction, cancer, and obstetric complications
  • Assessment findings: petechiae, purpura, ecchymoses, tachycardia, hypotension, cold/mottled fingers and toes
  • Medical management: correction of the cause, replacement of platelets, coagulation factors, and fibrinogen
  • Nursing management: assess pain, signs of infection, fatigue, bleeding, thrombus formation, urine output, safety, prevent infection

Palliative Care

• Definition: neither hastens nor postpones death, provides pain relief and reduces distressing symptoms
  • Integrates the psychological and spiritual aspects of care
  • Provides support system to help clients live as actively as possible until death
  • Referral to support system to help clients' families cope during the client's illness and in their own bereavement
• Hospice care
  • Initiated for patients as they near the end of life
  • Emphasizes quality of life
  • Patient and family are included in plan of care
  • Provides support for a dignified and peaceful death
  • Palliative rather than curative

Blood Disorders

• Anemia: deficiency of erythrocytes or hemoglobin
  • Causes: blood loss, inadequate erythrocyte production, destruction of formed RBCs
  • Assessment findings: inadequate RBC volume, tachycardia, tachypnea, cool, clammy skin, amenorrhea
  • Compensatory mechanisms: tachycardia, tachypnea, cool, clammy skin, amenorrhea
• Hypovolemic Anemia
  • Causes: sudden loss of large volume, chronic loss of small amounts of blood
  • Assessment findings: extreme pallor, tachycardia, hypotension, reduced urine output, altered consciousness, fatigue, chills, rapid respiratory rate
  • Medical management: blood transfusions, administration of oral, IV, or IM iron
  • Nursing process: monitor results of CBC, assess vital signs, monitor I&O
• Iron Deficiency Anemia
  • Causes: insufficient iron to produce hemoglobin
  • Assessment findings: reduced energy, feeling cold, fatigue, and dyspnea with minor physical exertion, rapid heart rate even at rest, decreased hemoglobin, hematocrit, and serum iron levels
  • Medical management: foods high in iron, blood transfusions
  • Nursing management: increase iron intake, collaborate with dietitian, administer iron supplement (IM Z-track)
• Sickle Cell Anemia
  • Causes: Hemoglobin A replaced by Hemoglobin S; sickle- or crescent-shaped erythrocytes from inadequate oxygen supply to blood
  • Assessment findings: jaundice, tachycardia, dyspnea, cardiomegaly, and dysrhythmias; stroke, acute chest syndrome
  • Medical management: supportive treatment, regular blood transfusions, bone marrow transplantation, prophylactic antibiotic therapy
  • Nursing process: assess health history, vital signs, physical assessment, evident dehydration, and pain; provide analgesics, oxygen, and fluids
• Hemolytic Anemia
  • Causes: chronic premature erythrocyte destruction
  • Assessment findings: jaundice, enlarged spleen, shock
  • Medical management: removing the cause, corticosteroids, blood transfusions
  • Nursing management: health history, supportive care, medication, teaching measures of self-care, arrange follow-up evaluations
• Thalassemia
  • Causes: hereditary hemolytic anemia
  • Assessment findings: Cooley's anemia: bronzing of the skin
  • Medical management: symptomatic, frequent transfusions, iron chelation therapy
  • Nursing management: bed rest, protect from infection, closely monitor blood transfusion
• Pernicious Anemia
  • Causes: lack of intrinsic factor necessary for absorption of vitamin B12
  • Assessment findings: stomatitis, glossitis, digestive disturbances, diarrhea, dyspnea with minimal exertion, jaundice, irritability, confusion, depression, numbness, and tingling in arms and legs, ataxia
  • Medical management: IM vitamin B12, physical therapy for permanent neurologic deficits
  • Nursing management: soft, bland diet, small, frequent meals, oral care, encourage and assist with ambulation, supervision
• Folic Acid Deficiency Anemia
  • Causes: immature erythrocytes, insufficient dietary intake of foods rich in folic acid
  • Assessment findings: severe fatigue, sore and beefy-red tongue, dyspnea, nausea, anorexia, headaches, weakness, light-headedness
  • Medical management: folic acid supplements, balanced diet
  • Nursing management: teaching, diet, oral hygiene, rest promotion

Leukocytosis and Leukemia

• Leukocytosis: proliferation of leukocytes, usually in immature form
  • Causes: genetic correlation, precipitating factors
  • Assessment findings: severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
  • Medical management: antineoplastic drugs, transfusions, transplantation: bone marrow, stem cell
  • Nursing process: assess history of symptoms, physical assessment, laboratory results, assess neutrophil, monitor platelet counts, assess for signs of bruising and petechiae, report hematuria or epistaxis
• Leukemia
  • Types: acute and chronic forms of lymphocytic and myelogenous leukemia
  • Assessment findings: severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
  • Medical management: antineoplastic drugs, transfusions, transplantation: bone marrow, stem cell
  • Nursing process: assess history of symptoms, physical assessment, laboratory results, assess neutrophil, monitor platelet counts, assess for signs of bruising and petechiae, report hematuria or epistaxis

Cancer

• Definition: abnormal, unregulated cell growth; neoplasms
  • Classifications: carcinomas, lymphomas, leukemias, sarcomas
  • TNM classification: tumor, node, metastasis
  • Stages: I to IV
• Etiology: genetic mutation, environmental factors, chemicals, radiation, viruses
  • Factors: chemical agents, environmental factors, diet, viruses, bacteria, medications, immune system
  • Signs and symptoms: headaches, weight loss, chronic pain, persistent fatigue, low-grade fever, infections
  • Diagnostic tests: client's history, physical examination, laboratory tests, imaging studies, biopsies
• Cancer treatment
  • Surgery: primary method of diagnosing, staging, and treating
  • Radiation: destroys cell by breaking a strand of DNA molecule, preventing growth
  • Chemotherapy: antineoplastic agents, cell cycle patterns
  • Targeted therapies: biologic response modifiers, monoclonal antibody immunotherapy, cancer vaccines
  • Stem cell transplant: replaces bone marrow destroyed by cancer or cancer treatments
• Nursing care plan
  • Nursing diagnosis: fatigue, imbalanced nutrition, disturbed body image
  • Interventions: encourage protein and calorie intake, plan care around energy level, administer antiemetics, explore strengths and resources

Coagulopathies

• Thrombocytopenia: platelet manufacture by bone marrow is decreased or platelet destruction by the spleen is increased
  • Causes: leukemia, malignant blood diseases, severe infections
  • Assessment findings: purpura, bleeding, internal hemorrhage
  • Medical management: eliminate cause, corticosteroids, transfusions
  • Surgical management: splenectomy
  • Nursing management: manage/minimize bleeding, apply pressure/tourniquet, ADR, taper corticosteroid dosage/frequency
• Hemophilia: clotting factor, inherited: mother to son
  • Assessment findings: oozing, severe bleeding, bleeding in joints
  • Diagnostic findings: coagulant factor assay
  • Medical management: transfusions, thrombin/fibrin application, fresh frozen plasma, direct pressure
  • Nursing management: health history, physical assessment, VS, prevent trauma, minimize bleeding, reduce pain or discomfort
• Disseminated Intravascular Coagulation (DIC)
  • Causes: shock, infections, trauma, burns, transfusion reaction, cancer, and obstetric complications
  • Assessment findings: petechiae, purpura, ecchymoses, tachycardia, hypotension, cold/mottled fingers and toes
  • Medical management: correction of the cause, replacement of platelets, coagulation factors, and fibrinogen
  • Nursing management: assess pain, signs of infection, fatigue, bleeding, thrombus formation, urine output, safety, prevent infection

Palliative Care

• Definition: neither hastens nor postpones death, provides pain relief and reduces distressing symptoms
  • Integrates the psychological and spiritual aspects of care
  • Provides support system to help clients live as actively as possible until death
  • Referral to support system to help clients' families cope during the client's illness and in their own bereavement
• Hospice care
  • Initiated for patients as they near the end of life
  • Emphasizes quality of life
  • Patient and family are included in plan of care
  • Provides support for a dignified and peaceful death
  • Palliative rather than curative